MR. MICHAEL SHANE SIEM (NPI# 1245483569) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245483569 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL SHANE SIEM |
| Credential | PA-C |
| Practice Address |
19020 33rd Ave W Ste 210 Lynnwood WA 98036-4748 |
| Practice Telephone | 4255631500 |
| Practice Fax Number | 4255631501 |
| Mailing Telephone | 4255631500 |
| Mailing Fax Number | 4255631374 |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2019-01-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA60056591 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA60056591 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | L&I-SWEDISH RADIA EDMONDS | 0377427 | 01 |
| WA | L&I-EVERGREEN RADIA | 0377418 | 01 |
| WA | 2011887 | 05 | |
| WA | L&I-RADIA REST OF WA | 0377409 | 01 |
| WA | L&I-RADIA KING COUNTY | 0377413 | 01 |
| Street Address |
19020 33RD AVE W STE 210 |
| City | LYNNWOOD |
| State | WA |
| Zip Code | 98036-4748 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477556868 | Prabhakar P. Kesava | Radiology | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2005-05-31 |
| 1861869661 | Elysia Bethany Louise Andrews | Physician Assistant | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2015-08-27 |
| 1962805226 | Ryan A. Gilbreth | Radiology | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2014-10-01 |
| 1154735561 | Harrison Patrick March | Radiology | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2014-06-13 |
| 1881005833 | Yasmin Syeda Akbari | Radiology | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2014-05-13 |
| 1225458839 | Nicholas Ryan Galloway | Radiology | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2014-04-22 |
| 1639598873 | Bradley David Griffitts | Radiology | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2014-04-15 |
| 1427476704 | Ryan Frederick Herde | Radiology | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2014-04-03 |
| 1679991442 | Xi Zhang | Radiology | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2014-03-31 |
| 1922432335 | Tamuna Chabra | Radiology | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2013-08-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396342630 | Zachary Perry | Behavior Technician | 4100 Veterans Way, Unit 100, Lynnwood, WA 98036 | 2020-10-08 |
| 1942832795 | Alexis Michelle Solomon-winne | Behavior Technician | 4100 Veterans Way Unit 100 Lynnwood, Wa 98036 United S, Lynnwood, WA 98036 | 2020-02-10 |
| 1881239028 | Endc Pllc | Psychologist | 19217 36th Ave W. Suite 219, Lynnwood, WA 98036 | 2019-11-12 |
| 1225507866 | Kyung Suk Seo | Massage Therapist | 18904 Hwy 99, Ste. K, Lynnwood, WA 98036 | 2018-11-13 |
| 1790270197 | Kabal Sriviboon | Behavior Technician | 20818 44th Ave W Suite 270, Lynnwood, WA 98036 | 2018-06-27 |
| 1992206148 | Kendal Ilyse Borison | Behavioral Analyst | 4100 194th Se, Suite 100, Lynnwood, WA 98036 | 2018-02-23 |
| 1205352515 | Doug Brant | Registered Nurse | 19931 Cypress Way, Lynnwood, WA 98036 | 2017-08-17 |
| 1588184980 | Evergreen Recovery Centers-lynnwood Detox | Substance Abuse Rehabilitation Facility | 20508 56th Ave W, Lynnwood, WA 98036 | 2017-06-27 |
| 1699213439 | Patrick J. Pacyga | Dentist | 19620 Wa-99, Suite 106, Lynnwood, WA 98036 | 2017-02-01 |
| 1134676646 | Fiona Green | Occupational Therapy Assistant | 21503 8th Place W, A, Lynnwood, WA 98036 | 2016-09-01 |
| Find all providers in zip 98036 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649887548 | Jesse E Davis | Physician Assistant | 3512 Serene Way, Lynnwood, WA 98087-5202 | 2020-09-25 |
| 1205307451 | Laniel Cua | Physician Assistant | 19221 36th Ave W Ste 201, Lynnwood, WA 98036-5700 | 2018-12-16 |
| 1043725328 | Emily Louise Hutchins | Physician Assistant | 4111 194th St Sw, Lynnwood, WA 98036 | 2017-12-07 |
| 1679090260 | Karielle B Jewell | Physician Assistant | 20200 54th Ave W, Lynnwood, WA 98036-6318 | 2017-08-24 |
| 1518315472 | Lamont Andante Scott | Physician Assistant | 4111 194th St Sw, Lynnwood, WA 98036-4604 | 2016-06-01 |
| 1861869661 | Elysia Bethany Louise Andrews | Physician Assistant | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2015-08-27 |
| 1174906176 | Jennifer Wilson | Physician Assistant | 4111 194th St Sw, Lynnwood, WA 98036-4604 | 2015-07-08 |
| 1265859664 | Meghan Mosbo | Physician Assistant | 4111 194th St Sw, Lynnwood, WA 98036-4604 | 2014-03-24 |
| 1205265998 | Lindsay Moran | Physician Assistant | 4111 194th St Sw, Lynnwood, WA 98036-4604 | 2013-11-04 |
| 1548425309 | Jose Anthony Ruiz | Physician Assistant | 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 | 2008-07-22 |
| Find all providers in LYNNWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.